不同心房颤动血栓危险度评分患者鼻内镜手术平均动脉压与局部脑氧饱和度变化的关系

Relationship between MAP and regional brain oxygen saturation in atrial fibrillation patients with different CHA_(2)DS_(2)-VASc in nasal endoscopic surgery

目的探讨不同心房颤动血栓危险度评分(CHA_(2)DS_(2)-VASc)患者行鼻内镜手术时MAP与局部脑氧饱合度(regional oxygen saturation,rSO_(2))的关系,及心房颤动患者rSO_(2)变化率与CHA_(2)DS_(2)-VASc评分的相关性。方法选择2019年1月至2020年12月首都医科大学附属北京同仁医院择期行全身麻醉鼻内镜手术的心房颤动患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ~Ⅲ级,性别不限,年龄>18岁,根据CHA_(2)DS_(2)-VASc分为低危组(L组,CHA_(2)DS_(2)-VASc≤2分)和高危组(H组,CHA_(2)DS_(2)-VASc≥3分)。分别于麻醉诱导前3 min(T_(0))、MAP较T_(0)降低10%(T_(1))和20%(T_(2))时,记录患者rSO_(2)和rSO_(2)变化率(ΔrSO_(2)%)。结果共纳入患者23例,L组13例,H组10例。与L组比较,H组年龄更大[(80.0±4.0)岁比(63.0±6.0)岁],T_(0)时MAP更高[(108.4±8.0)mm Hg比(88.4±11.2)mm Hg,1 mm Hg=0.133 k Pa],T_(2)时rSO_(2)更低[(61.2±3.8)%比(64.5±2.6)%],差异均有统计学意义(P<0.05)。T_(2)时,两组术前CHA_(2)DS_(2)-VASc与ΔrSO_(2)%呈中度负相关(r=-0.495,P<0.05)。结论心房颤动患者行全身麻醉鼻内镜手术,当MAP降低超过20%时,术前CHA_(2)DS_(2)-VASc越高,术中rSO_(2)下降的幅度越大。

Objective To evaluate the relationship between MAP and regional brain oxygen saturation(rSO_(2))in atrial fibrillation patients with different CHA_(2)DS_(2)-VASc in nasal endoscopic surgery,and to explore the correlation between rSO_(2)and CHA_(2)DS_(2)-VASc.Methods From January 2019 to December 2020,the patients with atrial fibrillation who underwent nasal endoscopic surgery under general anesthesia were selected,American Society of Anesthesiologists(ASA)Ⅱ or Ⅲ,aged≥18 years.According to the CHA_(2)DS_(2)-VASc,the patients were divided into low risk group(group L,CHA_(2)DS_(2)-VASc≤2 scores)and high risk group(group H,CHA_(2)DS_(2)-VASc≥3 scores).The index of rSO_(2) and ΔrSO_(2)% were recorded at 3 min before anesthesia induction(T_(0)),MAP decreased by 10%(T_(1))from T_(0) and MAP decreased by 20%(T_(2))from T_(0).Results A total of 23 patients with atrial fibrillation who underwent nasal endoscopic surgery under general anesthesia were enrolled,13 patients in group L,10 patients in group H.Compared with group L,the age of the patients was older in group H[(80.0±4.0)years vs.(63.0±6.0)years,P<0.05].MAP was significantly higher at T_(0) in group H than in group L[(108.4±8.0)mm Hg vs.(88.4±11.2)mm Hg,P<0.05;1 mm Hg=0.133 k Pa].The rSO_(2)was significantly lower at T_(2) in group H than that in group L[(61.2±3.8)%vs.(64.5±2.6)%,P<0.05].There was a negative correlation between preoperative CHA_(2)DS_(2)-VASc and ΔrSO_(2)% at T_(2)(r=-0.495,P<0.05).Conclusions When the decrease of MAP is more than 20% in the patients with atrial fibrillation who underwent nasal endoscopic surgery under general anesthesia,the higher the preoperative CHA_(2)DS_(2)-VASc,the greater the intraoperative decrease in rSO_(2).